Incentivizing Doctors Means Better Care For Patients, Study Finds

By Amir Khan, Everyday Health Staff Writer

Giving doctors monetary incentives to follow blood pressure guidelines resulted in better control for patients, according to a new study, and experts say these programs will likely become more common in the near future.

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TUESDAY, September 10, 2013 — Medical care is already expensive, but will paying doctors more result in better treatment for patients? It will, according to a new study published in the Journal of the American Medical Association. Researchers found that giving physicians monetary incentives to follow blood pressure guidelines resulted in a marked improvement in patients' hypertension control, and they say these programs will become more common in the coming years.

Pay-for-performance incentives were introduced as part of the Affordable Care Act, and to see the type of effect it could have on patient care, researchers from the Baylor College of Medicine conducted a study involving 83 doctors and 42 other health care personnel at Veterans Affairs hospitals throughout the country. The participants were split into three groups – individual doctors, who received $2,672, practices, which received $1,648, and a combination, which received $4,270 – to follow strict hypertension treatment guidelines.

The researchers found that when individual doctors were paid, blood pressure control improved by 8.36 percent, compared to a control group that did not receive any incentives. The same was not seen in the practice-level or combination group, according to the study.

"This is not a panacea for everything that is wrong in health care, but it can have a significant effect in improving care," study author Laura Petersen, MD, a professor of medicine at Baylor College and director of the Houston VA Health Services Research and Development Center, said in a statement.. "Pay for performance is attractive because it would be a system-wide plan that could be implemented on a wide scale.”

Hypertension is often difficult to manage, with only 50 percent of people with the disease controlling it. With more than 67 million adults affected by high blood pressure, an 8 percent increase in control could mean thousands more people get the disease under control and avoid the side effects of poorly controlled hypertension, including stroke, kidney disease and heart failure – but only as long as the incentives keep coming, researchers said.

"I thought the change would continue," Dr. Petersen said in the statement. "It was a long intervention and I thought people's practices would change over time. However, it shows that the incentives were working. If their performance had not fallen off [after the incentives were stopped], then we might question whether the incentives caused the effect in the first place."

Pay-for-performance incentives can be instituted beginning in 2014, and Saaron Laighold, MD, director of clinical cardiology for the North Shore-LIJ Health System in New York said he expects that many doctors will join these programs.

“This is the type of health care policy measure that seems likely to become more prevalent as the Affordable Care Act goes into effect over the next few years join these programs,” Dr. Laighold said. “These results do show that financial incentives can be an important tool in positively impacting patient care. As similar types of pay for performance initiatives are instituted by the Affordable Care Act, more research into the way that providers and patients respond will be important to guide health care policy.”

And while some people worry that these programs can lead to overtreatment, the study shows that’s not the case, as none of the incentivized doctors used more guideline-recommended medications than the control group. However, Dan Ehlke, PhD, assistant professor of health policy and management at SUNY Downstate Medical Center School of Public Health in New York City, said that doctors have to be careful not to let the incentives completely dictate how they treat patients.

“While it appears the risk of overtreatment as a result of incentive schemes is negligible, there is still cause for caution as to how such programs are implemented,” Dr. Ehlke said. “As in education, there is so much about medicine that cannot be traced to standard guideline adherence. Each patient is different, and we need to be careful that we don't penalize creativity and flexibility in the realm of medical treatment.”

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